How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.
Rates by insurance carrier
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Facility Modifier None Typical Low $1,122.02 Median $3,235.94 Typical High $12,589.25 | Facility | None | $1,122.02 | $3,235.94 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $43.65 Median $43.65 Typical High $9,332.54 | Professional | None | $43.65 | $43.65 | $9,332.54 |
Anthem BCBS Setting Facility Modifier None Typical Low $371.54 Median $794.33 Typical High $3,311.31 | Facility | None | $371.54 | $794.33 | $3,311.31 |
Anthem BCBS Setting Professional Modifier None Typical Low $28.18 Median $36.31 Typical High $61.66 | Professional | None | $28.18 | $36.31 | $61.66 |
CareSource Setting Facility Modifier None Typical Low $47.86 Median $537.03 Typical High $812.83 | Facility | None | $47.86 | $537.03 | $812.83 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $66.07 Typical High $794.33 | Facility | None | $50.12 | $66.07 | $794.33 |
Cigna Setting Professional Modifier None Typical Low $37.15 Median $45.71 Typical High $107.15 | Professional | None | $37.15 | $45.71 | $107.15 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $50.12 Median $66.07 Typical High $794.33 | Facility | None | $50.12 | $66.07 | $794.33 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $39.81 Median $45.71 Typical High $117.49 | Professional | None | $39.81 | $45.71 | $117.49 |
Molina Setting Professional Modifier None Typical Low $33.11 Median $40.74 Typical High $48.98 | Professional | None | $33.11 | $40.74 | $48.98 |
SummaCare Setting Professional Modifier None Typical Low $33.88 Median $37.15 Typical High $64.57 | Professional | None | $33.88 | $37.15 | $64.57 |
United Setting Facility Modifier None Typical Low $97.72 Median $275.42 Typical High $2,398.83 | Facility | None | $97.72 | $275.42 | $2,398.83 |
United Setting Professional Modifier None Typical Low $41.69 Median $52.48 Typical High $117.49 | Professional | None | $41.69 | $52.48 | $117.49 |
5 more rates with less common billing modifiers
A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $21.88 Median $21.88 Typical High $33.88 | Professional | 52 · Reduced service | $21.88 | $21.88 | $33.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $8.71 Median $8.71 Typical High $13.49 | Professional | 53 · Discontinued | $8.71 | $8.71 | $13.49 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $32.36 Median $32.36 Typical High $51.29 | Professional | 54 · Surgery only | $32.36 | $32.36 | $51.29 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.46 Median $6.46 Typical High $10.23 | Professional | 55 · Aftercare only | $6.46 | $6.46 | $10.23 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.37 Median $4.37 Typical High $6.76 | Professional | 56 · Pre-op care only | $4.37 | $4.37 | $6.76 |
Where Ohio sits
The same service costs 9.3 times more in Tennessee than in New York. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.
Ohio· 46th of 51
$50.12
Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.